Reflective learning is the cognitive process whereby information from new experiences is integrated into existing knowledge structures and mental models. In our complex healthcare system, reflective learning (specifically 'reflection on action') is important for postgraduate learners. We observed that our anaesthesiology residents were not building on their competence through deliberate experiential and reflective practice. This qualitative study explored the current state and challenges of reflective learning in anaesthesia training in Singapore.
The study was conducted at KK Women's and Children's Hospital, Singapore, from 1 January 2018 to 31 October 2018. A semi-structured interview format was used in focus groups. Information collection continued until data saturation was reached. The interviews were coded and analysed, and themes were identified. Seven focus group interviews involving 19 participants were conducted.
Reflective learning was found to be poor. It was of concern that the stimuli for reflection and reflective learning emerged from medical errors, critical incidents and poor patient outcomes. Challenges identified were (a) lack of an experiential learning framework, (b) need for reflective training, (c) quality of experiential triggers, (d) clinical pressures and (e) poor learner articulation and feedback. https://www.selleckchem.com/products/beta-aminopropionitrile.html We described some strategies to frame, teach and stimulate reflective learning.
This study described the state and challenges of reflective learning in anaesthesia training. We advocate the implementation of reflective training strategies in postgraduate training programmes in Singapore. Research is needed to integrate patient feedback and outcomes into reflective practice.
This study described the state and challenges of reflective learning in anaesthesia training. We advocate the implementation of reflective training strategies in postgraduate training programmes in Singapore. Research is needed to integrate patient feedback and outcomes into reflective practice.This study determined the distribution of sasX, qacA/B and mupA genes from methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical samples and nasal swab samples of the same patients and analysed their genetic relatedness.
Polymerase chain reaction (PCR) was used to detect the presence of sasX, qacA/B and mupA genes from 47 paired MRSA isolates. A paired isolate was defined as one nasal swab (colonising) isolate and clinical isolate that caused infection in the same patient. 22 selected paired isolates were subjected to multilocus sequence typing (MLST). The genetic relatedness among the isolates and association between the putative genes with epidemic sequence types (STs) were investigated.
7 (14.9%, n = 14) paired isolates were positive for the sasX gene. qacA/B genes were positive in 7.4% (n = 7) of the isolates, from three paired isolates and one clinical isolate whose paired colonising isolate was negative. The paired sample of three patients were positive for both genes. The mupA gene was not detected in all the isolates. MLST revealed two epidemic STs, ST22 and ST239, and a novel ST4649. sasX and qacA/B genes were found in ST239 in 29.5% (n = 13) and 13.6% (n = 6) of cases, respectively. Gene co-existence occurred in 13.6% (n = 6) of MRSA ST239 and 2.3% (n = 1) of MRSA ST4649.
sasX and qacA/B genes were present in the MRSA isolates, while the mupA gene was undetected. ST22 and ST239 were the major MRSA clones. The circulating MRSA genotypes conferred different virulence and resistance determinants in our healthcare settings.
sasX and qacA/B genes were present in the MRSA isolates, while the mupA gene was undetected. ST22 and ST239 were the major MRSA clones. The circulating MRSA genotypes conferred different virulence and resistance determinants in our healthcare settings.Mycotic aortic aneurysm (MAA) is a life-threatening condition. Endovascular repair (EVAR) of aortic aneurysms has been found to be a safe and effective alternative to open repair. We aimed to present the short- to medium-term outcomes for EVAR of MAA in our cohort.
We conducted a retrospective study of 23 consecutive patients with MAA who underwent EVAR in our hospital from January 2008 to July 2017.
The mean age of our study population was 62 years. The mean aneurysmal size was 3.2 cm. Abdominal MAA (n = 16, 70%) were the most common, followed by thoracic MAA (n = 4, 17%). There was no 30-day mortality in our cohort. Endoleak (Types 1, 3, 4) was detected in 3 (13%) cases. At the one-month surveillance computed tomography aortogram, all patients had a reduction in aneurysmal size and 5 (22%) had complete aneurysmal sac resolution. 7 (30%) patients had sac resolution at six months and 8 (35%) patients at 12 months. Overall survival was 91%, 80% and 61% at one, 12 and 60 months, respectively.
EVAR is a feasible and durable method for the repair of MAA, with a five-year overall survival of 61%. All patients in our study had a reduction in aneurysmal size at one month, with 65% having complete aneurysmal sac resolution by 12 months.
EVAR is a feasible and durable method for the repair of MAA, with a five-year overall survival of 61%. All patients in our study had a reduction in aneurysmal size at one month, with 65% having complete aneurysmal sac resolution by 12 months.The stillbirth rate is an important public health indicator. We studied the distribution of maternal and fetal characteristics and time trends of the stillbirth rate (SBR) at KK Women's and Children's Hospital (KKH) in Singapore from 2004 to 2016 based on various definitions of stillbirth.
Data was obtained from the Data Warehouse and Stillbirth Reporting System of KKH from 2004 to 2016. SBRs were calculated based on three definitions (fetal deaths at ? 20 weeks, 24 weeks or 28 weeks of gestation per 1,000 total births) and were described with maternal and fetal characteristics, and by year.
From 2004 to 2016, the SBR declined by 44.7%, 25.5% and 18.9% based on Definitions I, II and III, respectively. The SBR at KKH in 2016 was 5.2 (Definition I), 4.1 (Definition II) and 3.0 (Definition III) per 1,000 total births. The SBR was significantly higher in women aged ? 35 years, nulliparas and female fetuses. The number of live births at 24-27+6 weeks of gestation was more than four times higher than that of stillbirths (822 vs.